Ankle Arthritis Treatment Options

In this video, Dr. Baravarian discusses ankle arthritis and the advanced treatment options available at UFAI.

 

When you choose the University Foot and Ankle Institute for your ankle arthritis treatment, you've chosen a compassionate team of nationally recognized experts with decades of combined experience.

 

Our specialists speak to and train other doctors worldwide about the cutting-edge developments in treatment, techniques and innovative products available. All of which we've been intimately involved with for the last decade.

The Goal of Ankle Arthritis Treatment

The goal of ankle arthritis treatment is to keep motion in the joint and provide long term relief using the least invasive option possible. Less invasive treatment options can sometimes “buy time” for our younger patients and then treat the ankle with a more invasive option in the future. 

 

We are one of the few foot and ankle practices in the nation that offer the latest treatment options for all stages of ankle arthritis. From joint clean up to cartilage replacement, from ankle fusion to our state-of-the-art ankle replacement protocols, our physicians are nationally recognized experts on the entire spectrum of ankle arthritis treatments.

 

Recommended treatment options for ankle arthritis depend on the severity of the arthritis and the overall patient and include the following procedures.

 

 

Bracing and Custom Orthotics for Ankle Arthritis

Bracing for Ankle Arthritis, University Foot and Ankle Institute
This brace is for moderate arthritis and allows controlled motion of the ankle.

Many patients can benefit by simple accommodations. This can be achieved by using orthotics or bracing. Custom orthotics can control some of the motion at and below the ankle that may remove some of the stresses that are being put on the ankle joint.

 

This is usually effective in low-grade cases of ankle arthritis. Custom bases that cross the ankle joint can be very effective. These limit the amount of motion at the joint; less motion can lead to less pain.

 

These braces can be hinged to allow for some movement, or unhinged to allow for no movement.

 

 

Regenerative Therapy: Stem Cell and PRP Therapy for Ankle Arthritis

Ankle arthritis is a progressive disease affecting the ankle joints. The cartilage that normally cushions the joint and reduces friction between moving bones wears thin, and over time, the cartilage is destroyed. Bone spurs and scar tissue develop, causing stiffness and pain in the joint.

 

While there is no cure for arthritis, stem cell and platelet-rich plasma therapies can offer natural healing and longer-lasting results compared to traditional treatments.

 

Regenerative Medicine for Ankle Arthritis

Advances in regenerative medicine have revolutionized the way we treat degenerative podiatric conditions. As internationally-recognized authorities on regenerative medicine, the physicians at UFAI can provide you with the most innovative techniques in biomedical technology.

 

Regenerative medicine offers many patients the best chance at improving long term ankle function and joint restoration. At UFAI, we perform either stem cell therapy or platelet-rich plasma therapy, or a combination of both, to suit the patient’s condition and needs. Both therapies are minimally-invasive and can be used as an alternative or addition to surgery.

 

An Alternative to Steroids

Regenerative medicine is not a steroid injection. Corticosteroids suppress the body’s immune response, which is why steroid injections mixed with anesthetic can be used to reduce inflammation and pain in arthritic joints. However, this relief is typically short-lived. Steroids need to be readministered every 3-4 months. Moreover, long-term steroid use can further weaken the cartilage and tissue.

 

Stem Cell Therapy for Ankle Arthritis

Stem cells are undifferentiated cells with the potential to develop as any other type of cell nearby, including bone and cartilage. Their ability to “specialize” as cells of any other tissue or organ gives them their remarkable regeneration properties.

 

Stem cells can be derived from the fat or bone marrow cells in the patient’s own body, or from amniotic or placental donor tissue, and can be injected directly into the arthritic joint. As the cells multiply, they create new, healthy bone, cartilage, and connective tissue. Patients typically see a reduction in pain soon after treatment, and long-lasting results.

 

Platelet-Rich Plasma Therapy for Ankle Arthritis

Platelet-rich plasma is a super-charged healing agent derived from the patient’s own blood. A sample of blood is removed from the body and spun in a centrifuge to generate plasma that is densely packed with special blood cells called platelets. The plasma is then re-injected into the arthritic site. The platelets activate your body’s natural healing response, releasing growth factors that encourage healthy, rapid cellular proliferation.

 

Platelet-rich plasma and stem cell therapy are often used together, but they can be used on their own as well to address each individual patient’s needs.

 

 

Minimally-Invasive Ankle Arthroscopy

Ankle Arthroscopy is a minimally invasive surgery that can reduce pain and improve foot and ankle function in patients with ankle arthritis. This procedure cleans up the ankle joint, debriding scar tissue, damaged cartilage, loose cartilage, bone fragments, and bone spurs, allowing for restored mobility and decreased pain for your active life.

 

UFAI surgeons specialize in minimally-invasive procedures, which require no hospitalization and tend to be less risky and less painful than open surgeries. Minimally-invasive techniques also promote faster healing and recovery times to get you back to your normal routine.

 

Ankle arthroscopy is performed through two or three tiny incisions on the ankle. The surgeon inserts tools and removes tissue through the slits, guided by a lighted camera.

 

Stem Cell Therapy and Arthroscopy

Some patients might benefit from stem cell therapy in conjunction with ankle arthroscopy. Stem cells, derived from your own or a donor’s body, are “undifferentiated” cells with the potential to divide and specialize. As they reproduce, stem cells can become cells of any different type of tissue or organ. This is why stem cells are at the forefront of regenerative healing science.

 

During your arthroscopy, stem cells are injected into the ankle joint, where they begin to divide to form new cartilage, bone, and connective tissue. Platelet rich plasma, densely packed with healing cells, can also be injected to speed up the process. UFAI’s physicians are internationally-recognized leaders in regenerative technology for ankle arthritis.

 

Ankle Arthroscopy Recovery

Ankle arthroscopy is generally performed on an outpatient basis – no hospitalization required. The incisions are closed with sutures or staples, and your ankle will be fitted with either a compression stocking to reduce inflammation or a long splint to immobilize the ankle.

 

With minimally-invasive techniques and accelerated healing regeneration therapy, recovery from ankle arthroscopy takes place in a matter of weeks.

  • 3-4 days – Able to bear weight
  • 1-2 weeks – Return to work
  • 3-4 weeks – Return to normal activity levels
  • 4 weeks – Full recovery

 

It is best to take plenty of time to rest your ankle while it is recovering. If you must get around, crutches or a knee scooter may be helpful for keeping weight off the joint. Ice the ankle and use compression bandages to reduce pain and swelling during your rehabilitation.

 

Ankle Distraction Arthrolysis

This minimally-invasive technique focuses on joint preservation and restoration.

 

The procedure begins with an ankle arthroplasty but then there is a second step where an external frame is fixated across the ankle joint. The frame acts as scaffolding around the leg and allows the ankle to be distracted, or pulled apart, by 5-8 mm. The frame remains outside the body during treatment giving the cartilage "a rest" and a chance to heal. After 12 weeks, the frame is removed.

 

This older technique is still done with limited success. In the early stages of ankle arthritis, in conjunction with stem cell therapy, ankle distraction arthrolysis can be a good option. It is typically performed on young patients to avoid joint fusion or ankle replacement.

 

One advantage of distraction arthrolysis is that, if necessary, it may allow for ankle fusion or replacement in the future without any increased difficulty.

 

 

Ankle Replacement Surgery

Total ankle replacement, or ankle arthroplasty, is a surgical treatment for ankle arthritis that replaces the joint surfaces of the ankle with an artificial implant. Advances in biomedical technology have developed multiple types of implants to address individual patients’ needs, but each implant has three essential components:

  • A metal talar component, fitted onto the bone directly under the ankle
  • A metal tibial component, which caps the bottom of the shin bone
  • A plastic spacer, which creates the new joint

 

The implants enable motion in the joint and significantly reduce the pain of ankle arthritis.

 

Choosing the best arthroplasty implant for each patient is the first step towards a successful outcome. Our surgeons have extensive experience in all three types of ankle replacement surgery. This allows us to customize treatment and do what is best for each patient.

 

Goals of Ankle Replacement

The goal of total ankle replacement is to improve or preserve range of motion in the ankle and to reduce pain associated with ankle arthritis. Ankle replacement is typically considered after conservative treatment, such as activity modification, bracing, physical therapy, and anti-inflammatory and pain medication, have proven unsuccessful.

 

Ankle replacement can be performed on patients of any age, but may be better suited for patients older than 50, with activity levels ranging from low to moderate. In general, patients whose jobs or lifestyles are more physically demanding may require ankle fusion, a procedure which provides more stability.

 

Types of Ankle Replacement

Biomedical engineers are continually improving upon ankle replacement procedures and implants, testing for durability and efficacy. Our integrated team of surgeons, therapists, and imaging experts has extensive knowledge and experience working with a variety of devices and has helped to identify the right implant to address the needs of thousands of patients.

 

Our foot and ankle specialists choose from the following surgical implants to treat ankle arthritis:

 

InBone Prophecy

The InBone Prophecy system from Wright Medical is currently the most advanced ankle replacement system on the market. Very few surgeons have been trained and authorized to perform ankle replacement with this elite system. A CT scan of the ankle and a custom cutting guide helps to tailor the implant to fit the individual patient. 

 

This fixed-bearing implant achieves superior stability through its long stem, which extends into the tibia. The implant is securely fixed to the patient’s bone, which ensures stability, even for patients with weakened bones. The system’s design makes it a great choice for heavier patients or patients with a more active lifestyle.

 

Furthermore, the InBone Prophecy system dramatically reduces surgery time, decreasing pain and the risk of infection. The customized implant is easier to place and improves foot function suited to the patient’s needs.

 

Stryker STAR (Scandinavian Total Ankle Replacement)

The STAR prosthesis from Small Bone Innovations is the only mobile-bearing implant approved for use in the U.S. The plastic spacer “floats” between the tibial and talar components, which allows for side-to-side tilting motion.

 

The implant also reduces stress on the ankle through the adjacent joints, and in some cases this can prevent further arthritic damage. The STAR may be a good choice for patients who have severe or extensive arthritis in the surrounding joints. Its low profile construction leaves room for an InBone system later, should the need arise.

 

Infinity Total Ankle System
The Infinity Total Ankle System by Wright Medical is a another excellent option. When a CT guided ankle replacement system is used, Wright adds the word "Prophecy" to their system. For low profile settings, we prefer the efficiency and accuracy of the Wright Prophecy Infinity system.

 

The Infinity system has a bone-conserving design and multiple tibial component options to fit patient anatomy. As long as the bone quality is good and there are no major deformities, stability is very solid with this system.  

 

Salto-Talaris Total Ankle Replacement

The Salto-Talaris system from Tornier is a fixed-bearing device, but it actually has some mobile-bearing features. The implant mimics the ankle’s anatomy to recreate the normal flexion, extension, and rotational movements of a healthy ankle.

 

Like the STAR, the Salto-Talaris has a low-profile (allows your surgeon to retain more of your natural bone than other implants) and reduces stress through the nearby joints in the foot, but it is slightly more stable because the spacer is fixed to the bone components.

 

The Salto-Talaris does have its limitations, however. Any additional ankle deformities are difficult to correct when using this implant, and generally this device is only successful in patients with very low activity levels. Additionally, we find that the implant does not offer the same level of fixation and sophistication as the other implants mentioned and find that the dowel in the anterior cortex can cause weakness.

 

The Flaws of Agility from DePuy Synthes

At UFAI, we take pride in vetting the systems on the market. The Agility from DePuy is a poorly-designed device that was shown to fail time and time again. Agility required the fusion of the tibia and fibula (both long bones in the shin).

 

Our surgeons have evaluated this device and refused to place the Agility as well as any of its iterations in our patients. However, we are happy to replace a failed Agility implant with an advanced InBone device.

 

The surgeons at UFAI are at the forefront of ankle replacement surgical techniques and are internationally-renowned for their expertise in the three most effective, state-of-the-art devices. From your very first visit, we provide you with the very best in diagnostic testing, skilled surgery, and customized physical therapy.

 

 

Ankle Fusion for Ankle Arthritis

Jeff talks about his ankle fusion surgery and overall experience with UFAI.

Ankle fusion, also known as arthrodesis, is a surgical technique reserved for treating severe end-stage ankle arthritis. At UFAI, we prefer to explore every option before undergoing any surgical procedure, and we pride ourselves in avoiding fusion if at all possible.

 

However, some arthritis cases are so severe, causing debilitating pain to the patient, that ankle fusion may be the best route. Ankle fusion is a permanent solution to ankle arthritis. From stem cell and bone aspirate therapy to the lightest cast possible, to bone heeling minerals, we strive to make the procedure as easy and comfortable as possible for all patients.

 

Goals of Ankle Fusion

Ankle fusion is considered a joint-destructive procedure, meaning the patient will no longer have mobility in the joint. While this may sound extreme, patients with end-stage arthritis generally have already lost almost all ankle motion before treatment. Fusion can provide the ankle with stability and significantly reduce pain by immobilizing the joint.

 

Typically, the best candidates for ankle fusion are younger patients with active lifestyles or physically demanding jobs. Because fusion destroys the ankle joint, this may seem counter-intuitive. However, a successful ankle fusion will enable the patient to walk, and even withstand heavy stress, without pain. In fact, most patients notice very little change to their gait following the procedure.

 

Types of Ankle Fusion

All ankle fusions fit the same basic formula: what little cartilage remains in the joint is removed, and the two bones are held together in place with hardware, eliminating any more painful motion. The tibia (shin) and the talus then fuse together, often with the help of stem cell therapy.

 

However, ankle fusion is not a one-size-fits-all procedure. Each surgery is tailored to the individual patient’s specific needs. The surgeons at UFAI specialize in a variety of techniques, including minimally-invasive procedures performed arthroscopically through tiny, 1cm incisions.

 

Using our on-site CT scan, we can determine the extent of the damage to your joint and illustrate for you the best surgical options.

  • Three-screw method. This is the standard ankle fusion procedure. Three screws fix the bones together, and the area is injected with bone marrow stem cells to accelerate bone healing.
  • Multi-screw method. In this method, four or more screws are used to supply the ankle with additional support for patients that have greater weight-bearing needs, such as poor bone density or high body weight. Injecting bone marrow and stem cell concentrates can speed up recovery time for earlier weight-bearing.
  • Plate and screw method. When the subtalar joint (underneath the ankle and above the heel) is arthritic in addition to the ankle, a plate or rod can be used to immobilize and fuse both joints. This is the most stable of all ankle fusion constructs.
  • Ilizarov halo method. The halo apparatus is a multi-ringed device that encircles and supports the ankle fusion from the outside. The stainless steel or titanium rings, fixed to the bones with pins, transfer weight away from the ankle joint and into the halo device. This allows the tibia and talus to fuse.

 

Ankle Fusion Recovery

Following surgery, the ankle will be placed in a cast, and you will need to use crutches or a wheelchair for about 8-12 weeks. You will need to come in for periodic X-rays or CT scan to ensure the bones are fusing as expected. As the bones fuse, you will be able to bear weight and begin working with a physical therapist to complete your rehabilitation.

 

After your recovery, your foot and ankle specialist will fit you with a custom orthotic insert to aid in walking as normally as possible

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